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varanieliae tartrate 

CHAMPIX Film-Coated Tablets (varenicline tartrate) ABBREVIATED PRESCRIBING 
INFORMATION - UK (See Champix Summary of Product characteristics for full 
Prescribing Information). Please refer to the SmPC before prescribing Champix 
0.5 mg and 1 mg Presentation: White, capsular-shaped, biconvex tablets debossed 
with "Pfizer" on one side and "CHX 0.5" on the other side and light blue, capsular- 
shaped, biconvex tablets debossed with "Pfizer'' on one side and "CHX 1.0" on 
the other side. Indications: Champix is indicated for smoking cessation in adults. 
Dosage: The recommended dose is 1 mg vareniclme twice daily following a 1-week 
titration as follows: Days 1-3: 0.5 mg once daily, Days 4-7: 0.5 mg twice daily and Day 
8-End of treatment: 1 mg twice daily. The patient should set a date to stop smoking. 
Dosing should start 1-2 weeks before this date. Patients who cannot tolerate 
adverse effects may have the dose lowered temporarily or permanently to 0.5 mg 
twice daily Patients should be treated with Champix for 12 weeks. For patients who 
have successfully stopped smoking at the end of 12 weeks, an additional course of 
12 weeks treatment at 1 mg twice daily may be considered. Following the end of 
treatment, dose tapering may be considered in patients with a high risk of relapse. 
Patients with renal insufficiency: Mild to moderate renal impairment: No dosage 
adiustment is necessary. Patients with moderate renal impairment who experience 
intolerable adverse events. Dosing may be reduced to 1 mg once daily. Severe 
renal impairment. 1 mg once daily is recommended. Dosing should begin at 
0.5 mg once daily for the first 3 days then increased to 1 mg once daily. Patients 
with end stage renal disease: Treatment is not recommended Patients with hepatic 
impairment and elderly patients: No dosage adiustment is necessary Paediatric 
patients: Not recommended in patients below the age of 18 years Contraindications: 
Hypersensitivity to the active substance or to any of the excipients Warnings 
and precautions: Effect of smoking cessation: Stopping smoking may alter the 
pharmacokinetics or pharmacodynamics of some medicinal products, for which 
dosage adiustment may be necessary (examples include theophylline, warfarin 
and insulin). Changes in behaviour or thinking, anxiety, psychosis, mood swings, 
aggressive behaviour, depression, suicidal ideation and behaviour and suicide 
attempts have been reported in patients attempting to quit smoking with Champix 
in the post-marketing experience. Not all patients had stopped smoking at the 
time of onset of symptoms and not all patients had known pre-existing psychiatric 
illness. Champix should be discontinued immediately if agitation, depressed mood 
or changes in behaviour or thinking that are of concern for the doctor, the patient, 
family or caregivers are observed, or if the patient develops suicidal ideation or 
suicidal behaviour. In many post-marketing cases, resolution of symptoms after 
discontinuation of vareniclme was reported, although in some cases the symptoms 
persisted; therefore, ongoing follow up should be provided until symptoms resolve 
Depressed mood, rarely including suicidal ideation and suicide attempt, may be a 
symptom of nicotine withdrawal. In addition, smoking cessation, with or without 
pharmacotherapy, has been associated with the exacerbation of underlying 
psychiatric illness (e.g. depression). The safety and efficacy of Champix in patients 
with serious psychiatric illness has not been established. There is no clinical 
experience with Champix in patients with epilepsy At the end of treatment, 
discontinuation of Champix was associated with an increase in irritability, urge to 
smoke, depression, and/or insomnia in up to 3% of patients, therefore dose tapering 
may be considered. There have been post-marketing reports of hypersensitivity 
reactions including angioedema and reports of rare but severe cutaneous reactions, 
including Stevens-Johnson Syndrome and Erythema Multiforme in patients using 
vareniclme. Patients experiencing these symptoms should discontinue treatment 
with varenicline and contact a healthcare provider immediately. Pregnancy and 
lactation: Champix should not be used during pregnancy. It is unknown whether 
vareniclme is excreted in human breast milk. Champix should only be prescribed to 
breast-feeding mothers when the benefit outweighs the risk. Driving and operating 
machinery: Champix may have minor or moderate influence on the ability to drive 
and use machines. Champix may cause dizziness and somnolence and therefore 
may influence the ability to drive and use machines. Patients are advised not to 
drive, operate complex machinery or engage in other potentially hazardous activities 
until it is known whether this medicinal product affects their ability to perform these 
activities. Side-Effects: Adverse reactions during clinical trials were usually mild to 
moderate Most commonly reported side-effects were abnormal dreams, insomnia, 
headache and nausea. Commonly reported side-effects were increased appetite, 
somnolence, dizziness, dysgeusia, vomiting, constipation, diarrhoea, abdominal 
distension, stomach discomfort, dyspepsia, flatulence, dry mouth and fatigue. See 
SmPC for other less commonly reported side effects Overdose: Standard supportive 
measures to be adopted as required. Varenicline has been shown to be dialyzed in 
patients with end stage renal disease, however, there is no experience in dialysis 
following overdose. Legal category POM Basic NHS cost: Pack of 25 11 x 0.5 mg 
and 14 x 1 mg tablets Card (EU/1/06/360/003) £27.30. Pack of 28 1 mg tablets Card 
(EU/1/06/360/004) £27 30. Pack of 56 0.5 mg tablets HDPE Bottle (EU/ 1/06/360/001) 
£54.60. Pack of 56 1 mg tablets HDPE Bottle (EU/1/06/360/002) £54.60. Pack of 56 1 mg 
tablets Card (EU/1/06/360/005) £54.60. Not all pack sizes may be marketed / marketed 
at launch Marketing Authorisation Holder: Pfizer Limited, Sandwich, Kent, CT13 9NJ, 
United Kingdom Further information on request: Pfizer Limited, Walton Oaks, Dorking 
Road, Tadworth, Surrey, KT20 7NS. Last revised: 1 1/2009. Ref: CI7 

Adverse events should be reported. Reporting forms and information can be 
found at Adverse events should also be reported to 
Pfizer Medical Information on 01304 616161. 

For further information, please contact Pfizer Medical Information on 01304 616161 
or email 


varenicline tartrate 

Date of preparation: December 2010 CHA933X ©Pfizer 2010 
18/25 December 2010 

The highs and lows of 

From the last RPSGB president to Lansley's public 
health vision, we reveal the winners and losers 
in our end of year review 

gE» ( is or: tv now ! ) . J4> 


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Almost a year ago to the day, a 
certain Labour health secretary was 
revealing his latest vision for health 
services. Pharmacy will be a "crucial 
partner", his NHS strategy 
trumpeted, adding that the sector 
was "well-positioned to provide 
personalised health advice within 
local communities". 

Roll forwards 12 months and this 
time we have a different health 
secretary - but an all too familiar 
NHS vision (the public health white 
paper) championing the contribution 
that community pharmacy can 
make. And there you were, thinking 
it was just the BBC that showed 
repeats at Christmas. 

But while we may think that the 
same old visions keep coming 
around, a closer look at the news 
this week shows just how much 
community pharmacy has moved on 
as we hit the end of 2010. 

Portsmouth's Healthy Living 
Pharmacy (HLP) scheme (p7) is 
probably the highlight of the year, 
demonstrating as it does real and 
tangible patient outcomes. 

It's no surprise, then, that 
pharmacy minister Earl Howe took a 
trip to the south coast to see the 
results first hand. And his willingness 
to consider how the scheme could 
be incorporated into a national 
contract speaks volumes for how the 
current government views 
pharmacy. The only blight being the 
insistence that HLPs be funded 
locally - a view that continues to 
divide opinion and one that fails to 
deliver anything other than a 
postcode lottery of services. 

Sainsbury's decision to allow 
CPs to run surgeries from its 
consultation rooms (p6) is another 
demonstration of how far the sector 
has come. A year or two ago, stories 
such as these barely made it onto 
the radar, but there can't be a major 
pharmacy operator that isn't piloting 
similar schemes now. 

And it's not just companies that 
have made progress this year. The 
news that 98 per cent of 
pharmacists who had their CPD 
reviewed this year met or exceeded 
the regulator's standards shows the 
way that individual practitioners 
have accepted the need to review 
and hone their professional skills. 

This is perhaps a more significant 
development than many of the more 
high-profile changes this year - for 
without an enthusiastic and engaged 
pharmacist workforce, the sector 
will find it difficult to capitalise on 
the latest NHS opportunities. The 
news, then, that charity Pharmacist 
Support has seen a doubling of calls 
from pharmacists in the past couple 
of months (p7) should serve as a 
reminder that we need to do more to 
help pharmacists deliver the best 
service for their communities. 
Gary Paragpuri, Editor 

We wish you all a very merry 
Christmas and happy New Year 
on behalf of everyone at C+D. 
We'll be back on January 15 
with our next issue - but you 
can catch up online if you can't 
wait till then. 

6 82 per cent get 'excellent' CPD score 

8 Calls for transparency over pricing errors 

12 Analysis: CPs in dispensaries 

16 Your Shout: Debating drug dosing 

18 Xrayser and David Reissner 

22 2010 review: The year that was... 

28 C+D Awards 2010: Triple whammy 

29 Classified 
34 Postscript 

19 Update: Eczema, part 2 

The management and treatment options 

21 Practical Approach 

Effect of exercise on drug activity 

26 Category M Barometer 

How January's tariff will affect your pharmacy 

© UBM Medica, Chemist+Druggist incorporating Retail Chemist, Pharmacy Update and Beauty Counter. Published Saturdays by UBM Medica, Ludgate House, 245 Blackfnars Road, London SE1 9UY C + D online at Subscriptions With C + D Monthly pncelist £250 (UK), without pncelist £205 (UK) ROW price £365 Circulation and subscription, UBM Information Ltd. Tower House, Sovereign Park, Lathkill St, 
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to receive sales information from other companies please write to Lisa Taylor at UBM Medica Origination by ITM Publishing Services. Central House, 1 42 Central St, London EC 1 V 8AR Printed by Headley Brothers Ltd. The Invicta 
Press, Queens Road,AshfordTN24 8HH Registered at the Post Office as a Newspaper Volume 274 No 6772 

18.12.10 5 


CPD review sees 82% getting 
'excellent' score, says GPhC 

Regulator reveals 98 per cent of pharmacists met or exceeded CPD standards 

Hannah Flynn 

h a n n a h. f ly n n@u n i 

Almost 98 per cent of pharmacists 
have met or exceeded the expected 
standards when submitting their 
CPD for review by the regulator, the 
GPhChas told C+D. 

The Council said of the more than 
8,000 records reviewed in the first 
year of the process to July 2010, 
82 per cent achieved an 'excellent' 
score, and a further 16 per cent were 
rated as 'good'. 

'Excellent' ratings were given to 
pharmacists meeting 75 per cent or 
more of good practice criteria, and 
'good' scores to those meeting 
50-74 per cent. 

Less than 1 per cent of registrants, 
73 in total, were referred for non- 
submission, though only one case is 
so far set to be heard by the GPhC. 
People who have been referred for 
non-submission are given a chance 
to make up the deficiency, but if 
they fail to do this, they will be 
automatically removed from the 
register, GPhC post-registration 
manager Janet Flint told C+D. 

Sixty-five registrants removed 

Some pharmacists might not be 
making best use of their 
consultation rooms, the Department 
of Health's community pharmacy 
tsar has told C+D. 

Contractors could look to use the 
rooms to provide ancillary services 
such as podiatry, Jonathan Mason 
suggested. He was commenting on 
the decision by Sainsbury's to allow 
doctors to run medical surgeries 
from its pharmacy consultation 
rooms for up to 20 hour per week. 
He told C+D: "It is a concern some 
pharmacists may not be making best 
use of their consultation rooms." 

He said he was worried 
Sainsbury's service could be seen as 
pharmacists encroaching on CPs' 
territory and added: "Pharmacy 
should focus on delivering high- 
quality pharmaceutical services 
rather than part-time GP services. 
I would rather see pharmacists 
working with local health and social 

themselves from the register after 
their CPD was called for review, and 
19 cases have been referred to the 
fitness to practise board due to 
health concerns. 

These health concerns were either 
reported to the GPhC or became 
evident when registrants were 
contacted regarding their CPD 
records, the GPhC told C+D. "Fitness 

care providers to offer consultation 
rooms for ancillary services." 

If doctors were going to offer 
services from pharmacies, Mr Mason 
suggested private services such as 
for erectile dysfunction could be 
useful, delivered from a standard 
consultation room when other 
access to GPs was limited. 

John D'Arcy, managing director at 

to practise will deal with this as 
any other health problem We will 
ask them for a medical report," Ms 
Flint said. 

The GPhC is currently consulting 
on its CPD record procedures and 
the deadline for responses is 
February 7. 

Due to the cost incurred by 
processing paper records, Ms Flint 

Numark, agreed empty consultation 
rooms were not desirable. Very few 
consultation rooms would be in 
continuous use, he told C+D, adding: 
"Space is money so the space lying 
idle is not ideal " ZS/MR 

Doctors in dispensaries: friends 
or foes? 

See analysis, page 12 


1 1 

said the regulator was considering 
introducing a charge for records not 
completed online. "We might 
introduce a charge for paper records, 
as those who are submitting online 
are subsidising everyone else, so we 
are thinking about it," she said. 

Of records so far reviewed, 87 per 
cent were submitted electronically, 
the GPhC reported 

Plan need for 
NHS savings 

The government must come up with 
a "credible plan" to make the NHS 
efficiency savings it has promised, 
the House of Commons Health 
Committee has warned 

The government's plans would 
test the NHS to the limit, chair of 
the committee Stephen Dorrell said. 

And he warned such change was 
unprecedented. "We do not believe 
that the government is providing a 
clear enough narrative on its vision 
of how these savings are to be 
made," the committee said in its 
report on public expenditure. 

An efficiency saving of 4 per cent, 
four years running was required, Mr 
Dorrell said. "There is no precedent 
for efficiency gain on this scale in the 
history of the NHS, nor has any 
precedent yet been found of any 
healthcare system anywhere in the 
world doing anything similar." ZS 

Sainsbury's decision to allow CPs to run surgeries from its consultation rooms is 
dividing debate. Read the analysis on p12 

Empty consultation rooms concern 

6 Chemist+Drueeisi 18.12.10 

Breaking news online - updated daily 


Stress levels are rising, 
support charity reports 

Calls to helpline double from those lacking confidence to practise 

Chris Chapman 

Many pharmacists appear to be 
lacking confidence in their ability to 
practice, possibly due to fears 
around the approach the new 
regulator will take and anxiety over 
the Elizabeth Lee case, charity 
Pharmacist Support has warned 

Calls to the charity's Listening 
Friends stress line had "more than 
doubled" in the past couple of 
months, charity manager Diane 
Leicester told C+D. 

And there had been an increase in 
the number of general enquiries 
received over the year, she said. 

Pharmacists' concerns tended to 

be complex, Ms Leicester said, but 
she added: "Of the people 
contacting the charity for assistance, 
many appear to share a common 
theme of what could be described as 
a lack of confidence in their own 
ability to practise 

"This could be as a result of fears 
surrounding the approach that the 
CPhC may take as a regulator, or 
more simply could be professional 
anxiety in the wake of the Lee case 
with professionals actively wanting 
to perform better." 

There had also been a growth in 
the number of requests for 
information relating to professional 
development, Ms Leicester revealed. 

The comments came after a 

report showed more than 50 
community pharmacists were 
referred to the National Clinical 
Assessment Service (NCAS) for 
performance concerns in its first 
15 months 

A total of 63 pharmacists were 
referred between April 2009 and July 
2010 to the service, including 52 
community pharmacists and 11 
hospital pharmacists. Seven 
pharmacists referred themselves to 
the service, while 49 were referred 
by NHS organisations 

Governance or safety issues were 
the most common reasons for 
referral, and were raised in 44 per 
cent of cases, with misconduct 
mentioned in 38 per cent. 

HLPs are tipped for wider rollout 

Earl Howe: evidence from Portsmouth's HLP scheme "will be an amazing help" 

Evidence gathered from 
Portsmouth's Healthy Living 
Pharmacy (HLP) scheme could be 
used for commissioning future 
pharmacy services nationwide, 
pharmacy minister Earl Howe 
has said. 

Earl Howe told participating 
pharmacies he was optimistic that 
the evidence gathered by the 
scheme would be positive. 

"I want to take a very close look at 
the results for Portsmouth. I can't 
pre-empt the PCT's decision-making, 
but the evidence will be an amazing 
help to them and public health," Earl 
Howe said. 

The HLP scheme was commended 
in the public health white paper 
released this month 

PSNCsaid Earl Howe had 
agreed there was a "strong 
argument" to incorporate the 
Healthy Living Pharmacy model into 
a national pharmacy contract, 

should early results be sustained. 

However, how the service was 
funded would have to be decided on 
a local level, Earl Howe told C+D. He 
said that if similar schemes were to 
be rolled out, then evidence would 
need to be available and any 
commissioning decisions would 

have to be made locally 

"They have to be locally driven 
and the product of a needs 
assessment," Earl Howe said. 

His comments came after he 
praised Portsmouth's HLP scheme 
at an all-party pharmacy group 
meeting last week. HF 

Time running out in insulin Mixtard 30 switch 

Patients are running out of time to 
switch from insulin Mixtard 30, 
which will be withdrawn on 
December 31. 

The discontinuation of the insulin, 
used by an estimated 90,000 
patients, was announced by 
manufacturer Novo Nordisk in June 

as part of a phased withdrawal of all 
types of human insulin. 

Patients still on the insulin were 
advised to consult a healthcare 
professional to ensure they are 
switched to another treatment. 

"The important thing now is to 
ensure everyone affected is switched 

onto an alternative before the 
medication is withdrawn," the 
charity Diabetes UK said. 

The warning followed a letter to 
pharmacists from manufacturer Lilly, 
advising that its prefilled insulin pens 
would be discontinued in favour of 
its KwikPen from April next year CC 

R PS votes yes 

Royal Pharmaceutical Society 
members have voted in favour of 
allowing student and associate 
membership. The ballot results 
revealed this week show that, 
on a 22.7 per cent turnout, 89.3 
per cent voted in favour of 
student membership and 81.2 
per cent of RPS members 
voted in favour of associate 

Bone density screening 

Bone density screening could 
offer opportunities for 
pharmacy, a recent trial exercise 
at Middlesex's Carter Chemist 
showed. PSNChead of NHS 
services Alastair Buxton said 
there was potential for such a 
service, which found 13 per cent 
of those screened were at high 
risk of fractures, to offer positive 
benefits to the NHS 

Avicenna director 

Avicenna has announced that 
David Coles is set to join its 
board as a non-executive 
director in the New Year. Mr 
Coles was formerly managing 
director at UniChem (now 
Alliance Healthcare) and chair 
of the BAPW. 

LAs 'back health role' 

Local authorities "strongly 
support" government plans to 
give them responsibility for 
public health as outlined in the 
NHS white paper, health minister 
Anne Milton has said. The 
comments came as a C+D poll 
found that half of respondents 
thought the proposal would 
make life for community 
pharmacy more complicated 
(see Dispensary Talk, p8). 

More on the above stories at 


NCSO endorsements 

The DH and National Assembly 
for Wales have agreed to allow 
NCSO endorsements for the 
following items for December 
prescriptions: citalopram 10mg 
and 20mg tablets, gapapentin 
100mg and 400mg tablets; 
sertraline 50mg tablets; and 
tamoxifen 20mg tablets. 

18.12.10 7 



Will involving local 
authorities in public 
health be good news 
for pharmacy? 

"It may well be a 
benefit as local 
authorities also 
have knowledge of 
the area - so with 
their involvement 
it could help 

pharmacy, but only time will tell' 
Patricia Ojo, Day Lewis, 
Bromley, Kent 

"Yes, but it will 
make things more 
complicated as it 
will mean 

introducing another 
tier for pharmacy." 
Cylab Chauhan, 
Malvern Pharmacies Croup, 

Web verdict 

Yes, it will give us someone new 
to influence 

|§9H 18% 

It probably won't make much 

No, it makes life more 

" 51% 

I'm not sure yet 

j 11% 

Armchair view: Less than 20 per 

cent of C+D readers said local 

authorities' new role in public health 

will be good for pharmacy. Over half 

fear it will make life more 


Next week's question: 

How was 2010 for you? Vote at 

Calls for transparency 
as errors plague pricing 

NHS Prescription Services 'leaves contractors in the dark' 

Zoe Smeaton 

Pharmacists are being "left in the 
dark" about prescription 
underpayments and should demand 
more transparency from paymaster 
NHS Prescription Services, a 
contractor has said. 

Graham Phillips, of Manor 
Pharmacy (Wheathampstead) Ltd, 
Hertfordshire, was underpaid for 
expensive items in July and August 
2010 and sought an apology. 

Mr Phillips complained about the 
lack of transparency in the initial 
responses he received from NHS 
Prescription Services. "Your standard 

reporting procedures leave us entirely 
in the dark as to what went wrong; 
what has been done to prevent 
recurrence and any meaningful 
details at all of the nature of the 
errors," Mr Phillips wrote. 

He told C+D: "It seems like they 
are wantonly avoiding transparency 
in their reporting process." 

In one example, Mr Phillips had 
been paid for only one tin of Pepti 
Junior, despite filing separately a 
prescription for 12 tins. "We're 
spending hours and hours filing 
prescriptions in more convoluted 
ways and it's not working," he said. 

John D'Arcy, managing director at 
Numark, said he understood 

contractors' frustration. "When 
you're dealing with complaints 
procedures, lack of transparency 
isn't something that would usually 
feature," he said. 

Denise Hebron, customer service 
manager at NHS Prescription 
Services, offered Mr Phillips "sincere 
apologies" for the errors, saying they 
had been human, not systemic. 

An NHS Prescription Services 
spokesperson told C+D it offered 
contractors "a high level of 
explanation" of adjustments for 
under- and overpayments. One in 20 
contractors asked for further detail, 
the spokesperson added, "which we 
are happy to provide". 

Clinical debate C+D's Chris Chapman looks at the evidence behind the headlines 

Should labels be harder to read? 

Labelling, it turns out, is a can of 
worms. Following on from the 
Pandora's Box of whether 
antibiotics should be labelled by 
times (a debate that's still raging 
on p16), another angle on how we 
label medicines has cropped up - 
from a pretty unexpected source. 

In a blog post on kooky mind- 
botherer Derren Brown's site last 
week, one of Derren's helpers 
raised an interesting point on 
fonts. Essentially, it discussed an 

experiment where various fonts were 
used to convey information, finding 
that participants retained more 
information when it was conveyed in 
a hard-to-read font. 

You may think this is a moot point 
- labellers aren't known for their 
range of fonts, after all, and 
medicines labels need to be read by 
everyone, including the short- 
sighted and those with dementia. 

But changing how medicines are 
labelled is something that's been 
discussed by the NHS. A study for 
Connecting for Health looked at 
whether applying 'Tall Man' lettering 
to commonly mixed-up drugs could 
cut down errors. Instead of the 
normal lettering, the drugs got 
capitals in the middle - turning into 
carBIMazole and carBAMAZepine. 
The accuracy of selection was 
then analysed. 

It was found that the Tall Man 

variant increased accuracy of 
recognition, and increased name 
perception, though when it came 
to minimising errors there was no 
significant difference. 

Overall, however, the study's 
authors recommended using the 
Tall Man variant across the NHS for 
drugs that look or sound alike. 

So where does that leave 
pharmacy? Still a little in the dark, 
I suppose - more research would 
be needed. That said, once again 
labels raise an interesting question. 

Would patients benefit from 
having their labels written in Comic 
Sans? And would Tall Man help you 
while dispensing? 

Let me know what you think. 

Chat with Chris on Twitter: 
or email chris.chapman@ 

i 18.12.10 

N ever Be 
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Check out what's on TV this week 

1,500 miss the 
GPhC deadline 

Restoration will cost more than £600 

Chris Chapman 

Almost 1,500 pharmacists will leave 
the register in January after failing to 
renew their membership with the 
General Pharmaceutical Council 
(GPhC), C+D can reveal. 

TheGPhC said 42,612 
pharmacists had re-registered by the 
November 30 deadline, which was 
around 97 per cent of pharmacists. 
This means over 3 per cent - 1,450 
pharmacists - are set to leave 
the register. 

The number, which includes 
voluntary removals, was lower 
than the average of 4 per cent in 
previous years, a GPhC 
spokesperson said. 

Pharmacists who did not renew 
by the deadline will still be allowed 
to practise until December 31. 

But anybody who missed the 

deadline, either through illness or by 
accident, should contact the GPhC 
immediately to minimise the impact 
on their working life, the 
spokesperson added. 

Restoration to the register would 
cost £100 to apply then £540 for 
reinstatement, and the time taken 
for an application to be approved 
could vary. 

Should a pharmacist continue to 
practise after having been removed 
from the register, they may face a 
fine or even up to two years in 
prison, advised Charles Russell 
solicitor David Reissner. 

"Registration of pharmacists and 
premises are the lynchpins of the 
entire system," Mr Reissner added. 

Around 8,818 pharmacy 
technicians, or around 97 per cent of 
those on the register, also renewed 
their registration by the deadline, 
the GPhC said. 

Pharmacist Si 

working for pharmacists & their families 
Our services 

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• Pharmacists • Retired pharmacists • Undergraduate or postgraduate 
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Pharmacist Support is <i registered charity, No 221438, and is funded by donations from pharmacists. This 
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Scalp and body gel launches 
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LEO Pharma has launched a scalp 
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Dovobet Gel is the first once-daily, 
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New vitamin D-calcium chew 

Seven Seas Haliborange has 
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month. The product has been 
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working for pharmacists & their families 

Opportunities for Volunteering 

Pharmacist Support is currently looking to recruit volunteers 
for its Listening Friends scheme. 

Listening Friends is a free and confidential helpline staffed by 
trained volunteer pharmacists who provide a listening ear to 
fellow pharmacists and pharmacy students struggling with 
stress, or simply in need of a sympathetic, non-judgemental 
person to talk to. 

Volunteers must be able to 
A^ ~~ ' commit to: 

^ • an initial training and selection day 
in Manchester, February 5th 201 1 
• 2 residential weekend training 
courses per year 
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■ up to 3-4 hours of your time per 

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scheme's experienced coordinators and its friendly and 
supportive network of colleagues. 

For full details visit our website at: 

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Nicorette Invisi Patch Product Information: 

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9cm-') releasing 25mg, 15mg and 10mg of nicotine respectively over 16 hours Uses: 
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Dosage: It is intended that the patch is worn through the waking hours (approximately 
16 hours) being applied on waking and removed al bedtime Smoking Cessation 
Adults (om W years ot age) For best results, most smokers are recommended to 
start on 25 mg / 16 hours patch (Step 1) and use one patch daily for 8 weeks Gradual 
weaning from the patch should then be initiated One 15 mg/16 hours patch (Step 2) 
should be used daily for 2 weeks followed by one 10 mg/16 hours patch (Step 3) daily 
for 2 weeks. Lighter smokers (i.e. those who smoke less than 10 cigarettes per day) 
are recommended to start at Step 2 (15 mg) for 8 weeks and decrease the dose to 
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25 mg patch (Step 1 ), which do not resolve within a few days, should change to a 1 5 mg 
patch (Step 2). This should be conbnued for the remainder of the 8 week course, before 
stepping down to the 10 mg patch (Step 3) for 4 weeks If symptoms persist the advice 


of a healthcare professional should be sought Adolescents (12 to 18 years): Dose 
and method of use are as for adults however, recommended treatment duration is 
12 weeks. If longer treatment is required, advice from a healthcare professional should 
be sought Smoking Reduction/Pre-Ouit Smokers are recommended to use the patch 
lo prolong smoke-free intervals and with the intention to reduce smoking as much 
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i.e. 25mg (Step 1) is suitable for those who smoke 10 or more cigarettes per day 
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starting on 25mg patch should transfer to 15mg patch as soon as cigarette 
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4 weeks Temporary Abstinence Use a Nicorette Invisi Patch in those situations when 
you can't or do not want to smoke for prolonged penods (greater than 16 hours) For 
shorter periods then an alternative Intermittent dose form would be more suitable (e g 
Nicorette inhalator or gum). Smokers of 1 or more cigarettes per day are recommended 
to use 25mg patch and lighter smokers are recommended to use 15mg patch 
Contraindications: Hypersensitivity Precautions: Unstable cardiovascular disease, 
diabetes mellrtus, renal or hepatic impairment, phaeochromocytoma or uncontrolled 
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been reported Erythema may occur ft severe or persistent, discontinue treatment Stopping 
smoking may alter the metabolism of certain drugs Transferred dependence is rare and less 
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effects of. and pain response, to adenosine Keep out of leach and sight of children and 
dispose of with care Pregnancy and lactation: Only after consulting a healthcare 
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References: 1. Tannesen P. et al. Higher dosage nicotine patches increase one-year 
smoking cessation rates: results from the European CEASE trial Eur Resp J 1999; 1 3:238— 
246. 2, Data on file -CEASE 3 

Date of preparation: November 2010 


For every cigarette, there's a 

Are doctors in dispensaries a 
friend or foe to the pharmacist? 

Sainsbury's is offering doctors use of its pharmacy consultation rooms, but is bringing GPs 
into dispensaries a good idea for pharmacists? Miriam Reissner and Zoe Smeaton report 

Putting doctors in pharmacy 
consultation rooms should enable 
CPs and pharmacists to work more 
closely together, as well as making 
use of spare capacity in the facilities, 
Sainsbury's claims. 

But the plans announced last 
week (C+D, December 11, plO) have 
hardly been met with friendly faces 

Royal College of General 
Practitioners' chair Clare Gerada 
condemned the move, saying: 
"Supermarkets should stick to selling 
fruit and vegetables." 

General practitioners would be 
sanctioned for selling tobacco 
products, alcohol and high 
calorie foods within their surgeries, 
she pointed out, concluding: 
"We would urge any GPs. .. to take 
a step back and consider how they 
are able to provide excellent 
generalist care in such 

And there was little mention from 
GPs joining the debate about how 
working more closely with 
pharmacists could be a benefit. 

But while many have sung Dr 
Gerada's praises, some in the 
community pharmacy sector 
have been less willing to dismiss the 
plans, saying bringing the two 
professions together could be a 
good idea. 

Working under the same roof 
makes communication easier, says 
Shamsul Islam, pharmacy manager 
at Britannia Pharmacy, located in the 
Loxford Polyclinic in London: "Any 
face-to-face meeting always has its 
own value. There is only so much 
you can do over the phone or 
by letter." 

Boots agrees having health 
professionals all on one site "works 
really well" and now has GPs linked 
to stores in 19 locations. Ian Brown, 

Could CPs in pharmacies help improve interprofessional relationships? 

healthcare development manager at 
the multiple, says it allows easy 
communication between the two 
professions about preferred 
medicines and availability of 

"I think it's also advantageous as 
an opportunity for the pharmacist to 
get involved in MURs - that works 
really well having a resident GP. In 
some of our stores the GP has 
invited the pharmacist into the 
consultation with the patient," 
he says. 

And John D'Arcy, managing 
director at Numark, says bringing 
the two together can help build 
strong relationships and give doctors 
a better idea of what pharmacy 
does. As Mr Islam concludes: 
"Working together can lead to 
professionalism and emphasise what 
the NHS is trying to do - bring 
excellence to life." 

There is no doubt, then, that 
getting the professions working 
together is a good thing, but is 
letting doctors work from 
dispensaries the right way to 
achieve that? 

Sainsbury's says the move means 
it can make the most of consultation 
rooms, which are not always in use. 
But others have reservations. Mr 
Brown says the Boots model, which 
provides GPs with purpose-built 
facilities rather than using 
consultation rooms is "much 

And as Mr D'Arcy points out: "If 
the consultation room is not 
available for use by the pharmacy, 
this would mean that patients will 
be denied access to MURs, EHC, 
weight management and other 
services when it is occupied by 

Furthermore, although 
Mr D'Arcy says having a medical 
surgery in the dispensary could 
have a halo effect, with some 
customers seeing it as making the 
pharmacy in some way superior, he 
adds: "I do not believe that simply 
putting a GP in the pharmacy will of 
itself make the pharmacy 'more 

"The professionalism of the 
pharmacy is something that flows 
from the design and layout and the 

attitude and approach of the staff 
working in it." 

And although using the 
consultation room during 'down 
time' could indeed be making best 
use of resources, Jonathan Mason, 
the DH community pharmacy tsar, 
says he would rather see 
pharmacists working with local 
health and social care providers to 
offer ancillary services such as 
podiatry from their consultation 

"I worry that [the Sainsbury's 
model] would be seen as pharmacy 
trying to encroach into GPs' 
territory," he says. 

"Pharmacy should focus on 
delivering high-quality 
pharmaceutical services rather than 
part-time GP services." 

It seems, then, that it might be 
better for pharmacists to look for 
other ways to forge links with GPs. 
Jeremy Main, managing director at 
Alliance Healthcare, suggests 
pharmacists find out what local 
doctors need. 

"There might not be something 
for every pharmacy or GP, but there 
may be opportunities that can be 
developed following an open 
conversation," he says. 

Sainsbury's clearly believes the 
consulting room surgery model will 
be the answer, but as Fin McCaul, 
chair of the independent pharmacy 
federation, concludes, it's pretty 
hard to tell yet whether it will be 
positive or negative for community 

Whatever the answer on that 
specific model, though, it's clear that 
thinking about innovative ways to 
start working with doctors is going 
to be vital as NHS reforms take 
shape - and now might not be a bad 
time to start. 

/'/•■:' 7011 Have you guided your pharmacy to success with your 

incredible management skills, attitude and motivation? 
You could win the C+D Award for Manager of the Year. Enter now at: 






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+D Awards 2011 

The C+D Awards 201 1 are back and open for entries. 
With 1 A categories to choose from, make sure you don't 
miss out on the chance to become a C+D Award winner 

In association with 


National Pharmacy 
Association a 

The Award categories 

Community Pharmacist of the Year 

A great community pharmacist has many strings 
to their bow. Whether you are a manager, long- 
term locum, run your own pharmacy, or act as 
superintendent, you strive to be the best. You are 
a leader in your field, combining the day-to-day 
running of the pharmacy with leading edge 
practice, be it clinical, business, or management. 
Tell us how you have maximised delivery of your 
contract, developed clinical services and built links 
with patients and peers. An all-rounder who 
doesn't compromise one aspect of the job for 
another, you should be able to show how you 
have engaged the whole pharmacy team to help 
your patients. 

Pre-registration Graduate of the Year 

Making the transition from classroom to frontline 
practice can be a big step for pre-reg graduates. 
And the best will be able to demonstrate an 
ability to combine clinical knowledge with 
everyday practice to deliver services that benefit 
their patients. The winner of this award isn't just 
your regular pre-reg; they will have set themselves 
apart from their peer group with their drive, 
ingenuity, ideas and commitment to make a 
difference to their patients. Tell us what you have 
done and why, how you did it and what you have 
learnt from your experiences that will help you in 
your future career. 

New Pharmacist of the Year 

Like Usain Bolt, you're no slouch out of the 
starting blocks. Whether you work as a branch 
manager, a relief pharmacist, owner, locum or in 
head office, you have achieved more than you'd 
believe possible in the five years since registration. 
Tell us how you've developed your skills and 
knowledge and networked with your peers, as you 
set the foundation for a successful professional 
career With an appreciation of how the NHS 
landscape is changing, you'll be able to 
demonstrate how you are developing or rolling 
out pharmacy services that help your patients and 
develop your clinical and business skills. Please 
state when you qualified 

Pharmacy Manager of the Year 

Whether you work at the coalface as a pharmacist 
or technician, or in head office as superintendent, 
or as a cluster manager or area manager, you have 

an innate ability to make things happen. Your 
terrific management skills and ability to sort the 
wheat from the chaff mean you can help turn a 
failing business or service into an award-winning 
initiative. A great motivator, tell us how you have 
helped colleagues achieve their goals, helped the 
pharmacy hit its targets, or helped your company 
rollout initiatives. Your can-do attitude means you 
deliver on time, to budget and always to a high 
standard. A broader category than Community 
Pharmacist of the Year, this award is open to 
anyone who holds a managerial position. 

Pharmacy Technician of the Year 

For every great pharmacist, there's an equally 
excellent technician. With an eye for detail, an 
ability to multitask and a willingness to go the 
extra mile, the winner of this award will make 
everything tick in their pharmacy. Whether you 
have improved safety or efficiency in the 
dispensing process, taken on delivery of clinical 
services, management responsibilities, or 
mentored colleagues, your entry should 
demonstrate what you've achieved, how you 
did it, and the measures of success. The role of 
technicians is rapidly expanding and this is your 
chance to show how you are making a difference 
to your patients. 

Pharmacy Assistant of the Year 

Assistants are the face of pharmacy and deal 
with millions of patient requests every year. 
The winner of this award will be a friendly and 
familiar face to their customers and an example 
to their colleagues. Simply doing the job well 
isn't enough - the winner needs to go a step 
further. Whether you have helped recruit 
patients to your pharmacy's services, delivered 
health promotion activities, or forged links 
with your local community, the C+D Awards is 
your opportunity to show how important you are 
to the pharmacy team. Entry can be by 
nomination or by self-entry. Testimonials play a 
key part in this category - so make sure you 
include them. 

MUR Champion of the Year 

Medicines use reviews are a central plank of 
pharmacy practice in England and Wales. Whether 
you work with your PCT or CP or whether it's an 
opportunistic service, MURs allow pharmacists 
to engage with patients on a one-to-one basis 

14 jggisl 18.12.10 

For Awards hints and tips and a sample entry go to: 


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For details of how to enter, including category questions, hints 
and tips and a sample entry go to 

and demonstrate the benefits of good 
pharmaceutical care. As well as showing how 
you have found the time, skills, knowledge 
and support from your team to make MURs a 
routine part of your daily practice, your entry 
must above all demonstrate the impact this has 
had on your patients Whether you saved a life, 
spotted an ADR, or picked up an interaction, tell 
us how you are using MURs - targeted or 
otherwise - to make a difference to your patients. 
You must submit a sample (anonymised) MUR 
for assessment. 

Clinical Service of the Year 

There's no such thing as a run-of-the-mill clinical 
service - every single one has the potential to 
deliver life-changing patient benefits. And 
whether you provide, for example, a substance 
misuse service, an anticoagulation clinic, vascular 
screening, weight management or palliative care, 
the opportunities for pharmacists to deliver great 
clinical services are more diverse than ever. It goes 
without saying that your service has to be well 
executed but, above all else, it has to demonstrate 
that it meets a local health need. Tell us how you 
identified the need and made it happen and most 
importantly how it's made a difference to your 
patients Entries can be from an individual, 
primary/community/hospital pharmacy team or 
multidisciplinary team, but the service must have 
a community pharmacy component. 

NEW Pharmacy of the Year 

Community pharmacy's enduring ability to 
seamlessly deliver health services in an accessible 
retail environment is what makes the sector so 

In today's increasingly competitive professional 
and business landscape, this skill has become even 
more vital. Every pharmacy - from the biggest 
multiple to the smallest independent - has to 
balance the demands of delivering a modern 
patient-centred health service while offering a 
customer experience that rivals the big high street 

The best pharmacies have turned this into an 
art form with warm, inviting, premises, welcoming 
and knowledgeable staff and accessible services 
that together make for a great customer 

Winning this award is not about how much 
you've spent, it's about what you do with the 
investment. Whether you've undertaken a 

top-to-bottom revamp of your pharmacy, 
launched a successful private health service, or 
used your IT systems to increase your efficiencies 
for example, tell us how the changes have 
propelled your pharmacy from the also-rans to 
the top of the podium. Entries must include 
information on the gains made. 

Business Initiative of the Year 

Great businesses never stand still. They continue 
to innovate, evolve and raise the bar for their 
competitors. And it's not just about throwing cash 
at problems - it's about the creative ideas that 
genuinely move your business forward. There 
could be a multitude of initiatives you have 
introduced, but here's a few suggestions to get 
you started: you might have improved your 
dispensing service through new workflow 
processes; unlocked the wealth of data in your 
PMR system to launch targeted support services; 
utilised robotic technology to free up your 
pharmacy team; relocated into bespoke premises; 
cut your carbon footprint, won a commissioning 
bid, found a novel way of delivering MURs; 
rolled out a hub and spoke dispensing model; set 
up a virtual head office; rolled out a new 
professional service; or developed a mobile 
service. The list is endless, but the judges will want 
to see how your business and your customers 
have benefited. 

Pharmacy Team of the Year 

Every great pharmacy has at its heart a great 
team. Like the US astronaut crews of the 1960s, 
the magical Brazilian football team of the 1970s or 
the Chilean miners of this summer, great teams 
are dedicated, knowledgeable, hard working and 
capable of delivering far more than their 
constituent parts. The winners of this category 
could be a pharmacy team or a multidisciplinary 
team (but with a majority community pharmacy 
component). Tell us how your team works 
together, their strengths and skills, how they have 
solved problems or gone the extra mile to help 
patients and how they make their pharmacy a hit 
with their community. There are some truly 
magnificent pharmacy teams, so don't miss your 
chance to get the recognition that you deserve. 

Pharmacy Innovation of the Year 

Take your pick - professional, retail, clinical, 
business or management - there isn't a field in 

which community pharmacy doesn't innovate. 
Robotic dispensing, online pharmacies, web-based 
repeat prescriptions, bespoke clinical services, 
CPD support, hub and spoke dispensing - these 
are just some of the ways in which pharmacy has 
taken a tried and trusted formula and made it 
better. Tell us everything about your innovation: 
how you came up with the idea, how you made it 
happen, the hurdles you overcame and the 
benefits for you, your team and your patients. It's 
not so much about how much you spend, but 
about the creative spark that set you on the way 
and the improvements you delivered as a result. 


There are few genuine landmark victories in life 
and, for pharmacy, achieving prescribing status is 
clearly one of them. It's a real recognition of what 
the profession can offer patients and many of 
the pioneering pharmacist prescribers are 
already making a difference to the quality of care 
provided to their patients. Whether you're an 
independent or supplementary prescriber, 
the C+D Awards is your chance to showcase your 

Tell us how you have made a difference as a 
prescriber, for example by improving medicines 
compliance, creating formularies, or helping your 
colleagues to achieve similar successes. But most 
of all, tell us how your work has benefited 
patients - whether it's cutting CP or hospital 
visits, redefining patient pathways, increasing 
access to services or measurably improving health 
outcomes - this is where you will score with the 
judges. Entries must include proof of your 
prescribing qualification. 

The pharmacy sector, with its mix of high street 
brands and local community pharmacies, is 
blessed with some of the finest business minds. So 
whether you're a chief executive, senior director, 
area or cluster manager, PCT pharmacist, a single- 
handed owner and whether you work for a 
multinational company, LPC, wholesaler or local 
pharmacy, now's your chance to get the 
recognition your efforts deserve. Tell us about 
your vision and how you make it happen. Tell us 
how you unite your team and how you develop 
those all-important contacts and tell us how your 
efforts make a difference to you, your colleagues, 
and your customers. Entry can be by nomination 
or by self-entry. 

18.12.10 15 


Got a view that you want to get off your chest? 
Email it to 

Your Shout 

Whether you want to share your experiences, get something off your chest, or ask C+D to put your questions 
to the industry's experts, Your Shout is your opportunity to do so. Get in touch with us by emailing and we'll make sure your views are heard 

Should dose times be on labels? 

A C+D comment on the information pharmacists should provide about dosing intervals provoked 
a debate at We look at some of the best responses 

Last month pharmacist Molica 
Kraszkoova wrote to C+D, 
suggesting antibiotic 
prescriptions should be labelled 
by hourly intervals rather than 
the number of times the drugs 
need to be taken each day. This, 
Ms Kraszkoova suggests, would 
make sure plasma levels stay in a 
therapeutic range. 

C+D's clinical & CPD editor 
Chris Chapman wasn't so sure, 
wondering what impact the 
change would have on 
compliance. Here's what you 
thought of the idea: 

® Isn't compliance the most 
important factor? Without it, there 
is less chance of achieving 
therapeutic plasma levels. 

Gastric upset is an issue in some 
patients, which may be alleviated 
by taking the antibiotic with or 
after food. The easiest time for 
this patient group to comply is 

We could put both sets of 
instructions on the label - for 
example 'take one every eight hours 
(three times daily)'. This covers both 
bases. Eoghan O'Brien 

® I agree that putting the timing of 
medications on prescriptions is 
vitally important. I do it for all slow- 
release opiates, for example. 

However, imagine a child needing 
penicillin V liquid. Are we really 
going to instruct the parent to dose 
at 6am, 12pm, 6pm and midnight? 

I suspect that we would do better 
to take each patient individually, 
then counsel appropriately with 
regard to dose timing to ensure the 
best level of concordance. 
Sean Whelan 

a We used to have an additional 
time label with the following times 
on it which we considered nearest 
possible without disrupting normal 

life: 7am, 12 noon, 3pm, 6pm, and 
bedtime. If it was three times a day 
we would cancel out 12 noon and 
6pm (to make it 7am, 3pm and 
bedtime), and if it was four times a 
day we would cancel out 3pm 
(hence the times would be 7am, 12 
noon, 6pm and bedtime). I hope this 
will be useful to all. Mayur Shah 

«■ I have always found reminding 
patients verbally that doses should 
be spaced as evenly as possible over 
24 hours to be most effective, giving 
suggested times if I receive a 
quizzical look. 

This often has the most impact 
when the medication is for a child, 
when I suggest the last dose be given 
at the parent's bedtime so the 
bacteria do not have such a long 
time to 'build back up'. 

I am a firm believer in the power 
of conversing with patients, and find 
those moments when the penny 
drops to be truly wonderful, as it is 
then that I am as sure as I can be 
that the medication will be used 
effectively. JemPharm 

© A constant plasma level for 
antibiotics is surely not always a 
benefit. Bacteria are most vulnerable 
when they divide (and multiply - 
clever things bacteria!) as the cell 
wall is weak. 

A period where the plasma level is 
low will allow the bacteria to start 
multiplying again and thus render 

the next rise in plasma level more 
effective than would otherwise be 
the case Mike Field 

® I usually try and put both times 
per day and the time of day on a 
label if I can, and the pharmacy I 
work in does 600+ items a day. 

I find in the UK if you put 'every 12 
hours' people invariably ring up 
when they get home and ask what it 
means, so in the long run it saves me 
time to write out both on the label. 
Susan Warman 

• In a busy pharmacy, [antibiotics] 
are one group of drugs I do make 
time for counselling patients about. 
Although I was trained in the UK, I 
have worked most of my life on the 
other side of the pond and we 
always labelled antibiotics 'every 
eight hours' or 'every 12 hours', not 
'three times a day' or 'two times 
a day'. 

I was rather shocked when I 
started working here to see 
prescriptions from CPs as 'three 
times a day' rather than 'every eight 
hours'. However, we rarely used 
antibiotics that require four doses a 
day; that is a huge compliance 
nightmare and requires extra 

A constant plasma level is 
essential, otherwise you are 
encouraging resistance to develop. 
We should all be using 'every eight 
hours' or 'every 12 hours' and 

reinforcing with counselling. The 
same goes for opiates such as MST. 
Change it to time intervals. Hilary 

o Would using a seven-day 
monitored dosage pack with printed 
dosage times help? 
John Jones 

• My dad (a lecturer in instrumental 
methods of analysis) always said 
that penicillin V had such a short 
half-life (30 minutes) it didn't make 
any difference. Other antibiotics 
have a longer half-life, but still not 
enough for the dosing interval to be 
critical in many cases. Judith Hible 

Have your say 

Do you think prescriptions 
should start including time 
intervals? What effect do you 
think it would have on 
compliance? Let us know what 
you think: email 

Ethical Dilemma 

Last month's Ethical Dilemma 
on confidentiality and 
November 27's Practical 
Approach on assisted dying saw 
hot debate on C+D's website 
and by email. 

A new Ethical Dilemma has 
now been posted on the 
website - and we want to know 
what you would do. Join the 
debate at www.chemistand 
or send in your suggestions to 

The best suggestions will be 
published along with expert 
legal opinion in the New Year. 

16 Chemist+Druggisi 18.12.10 



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What do you think? 

A pharmacist's Christmas Carol 


It's Christmas next week, there's snow on the 
ground, so sit by the roaring fire with the C+D and 
let me tell you a story. 

Twas the night before Christmas, and Scrooge 
Chemists was still open. "Can I go Mr Scrooge?" 
asked dispenser Bob Cratchit. 

"There may yet be another prescription," said 
Scrooge, "and we can't miss it!" But when Scrooge 
finally locked up, at the door was his old partner 
Jacob Marley who had died and become an agency 
locum. "Scrooge!" he said, "don't continue like 
this. I couldn't cope with all these new services 
and look at me now!" 

"The PCTs are being abolished," replied Scrooge, 
"so these stressful services will be gone and it's 
back to proper dispensing." 

But that night Scrooge was visited by three 
ghosts. First was the ghost of pharmacy past. 
"Look Scrooge - before new services, with all your 
training, in the 1980s you were a glorified shop 
keeper. But you were young and enthusiastic and 
you believed the profession could grow and 

"Yes," said Scrooge, "that's why I became a 
pharmacist - the contribution our access and 
availability meant to public health. I believed we 
could make a difference!" 

Soon after, the ghost of pharmacy present 
appeared. He showed Scrooge the tills ringing in 
supermarkets and drugstores selling traditional 
chemist goods, the directors of oxygen and ostomy 

supply companies growing fat on the profits of 
services, and private providers working with CP 
commissioning groups. 

"Everyone is having a good time apart from us," 
said Scrooge. "What are the pharmacists doing?" 

"You're squabbling over the last few scripts on 
the high street," the ghost said. 

Finally came the ghost of pharmacy future. 
"No, Spirit," said Scrooge, "I fear what you will 
show me." The ghost said nothing, but showed 
Scrooge Chemists closed and abandoned on an 
empty street, while patients struggled to large 
private health centres for a host of services from 
Dr Healthcare Ltd. 

"Are there no pharmacists left, Spirit 7 " Scrooge 
closed his eyes and wondered how he could have 
let this happen... 

When he opened his eyes it was still the present 
day. He looked out the window and saw it was a 
white paper Christmas. "I must change," said 
Scrooge, "I must fight for my profession, my job, 
my future!" 

So he rushed out to lobby the LPC, and PSNC 
He ran to his former competitors shouting: 
"We must work together! We must see our CPs 
and get involved with commissioning!" And he 
trained Bob Cratchit to be an ACT and stop 
smoking adviser. 

And so, gentle reader, we have all seen the 
future and we too must act - otherwise, as Tiny 
Tim observed: Cod help us, every one! 

What actions should warrant a conviction? 

There have been countless 
consultations affecting pharmacy 
this year, but one issue stood out 
from the crowd. 

Elizabeth Lee's conviction and 
sentence for a non-fatal dispensing 
error dominated the pharmacy 
world in 2010. 

In late November, the Law 
Commission, which has a proven 
track record of having its proposals 
translated into law, finished a 
consultation on proposals on the 
subject: Criminal liability in 
regulatory contexts. 

The Commission specifically 
looked at pharmacy, including 
dispensing and the safe custody of 
controlled drugs and related record 

The Commission proposed 
limiting criminalisation - for 
example, to cases where the harm 
done or risks should be regarded 
as serious enough to warrant it. 
The Commission's proposals 
extended not only to individuals, 

but also to cases where a company 
or company director could be 

Just as the Law Commission's 
consultation period ended, the 
MHRA, which has responsibility for 
reforming the Medicines Act, 
published an 'informal consultation' 
on whether the Medicines Act 
should be amended so that, where 
the defendant is a regulated 
healthcare professional, an offence is 
only committed if they are found to 
have acted with intent or negligence. 

I am not sure the MHRA has 
grasped the problem. Obviously, 
intentionally incorrect supplies 
should be criminal. But I do not 
understand the reference to 

Almost every incorrect supply of a 
medicine is unintentional and any 
unintentionally mistaken supply 
would be categorised by the courts 
as "negligence". 

The MHRA should recommend 
scrapping the existing laws and 

reversing the recent High Court 
ruling that a dispenser who selected 
and handed a patient incorrect 
medication was a criminal. 

You can email your comments to 
by December 22, 2010. There will be 
a formal consultation for 12 weeks 
from spring 2011, but why not try to 
mould the MHRA's ideas now? 

In 2011, watch out also for the 
Department's consultation on the 
way new control of entry regulations 
will operate and whether there will 
be a right of appeal against PCT 

These are your opportunities to 
have a say in the laws that govern 
your professional lives and 

David Reissner is a specialist in 
pharmacy law and head of 
healthcare at Charles Russell LLP 
Contact him on 0207 203 5065 
or email david.reissner@ 


18 Chemist-i 





▼ 19 Eczema: part 2 


^ 21 Pharmacokinetics 


^ 26 Category M 

Eczema: part 2 

The treatment options and stepped-care 
management of eczema 

Supported by 


Chinjal Patel MRPharmS PCDip 

The management of eczema involves the early 
identification and avoidance of triggers and the 
implementation of a stepped-care approach to 
treatment, as recommended by Nice. 1 This means 
increasing treatment when the condition is severe 
and reducing it when a flare is controlled. 

First-line treatments include emollient therapy, 
topical corticosteroids and anti-infective agents. 
Other treatments include topical tar and 
antimicrobial products, topical calcineurin 
inhibitors, phototherapy, systemic treatment, 
bandages and medicated dressings. 

Emollients are the mainstay of eczema 
management. They restore the epidermal barrier 
and prevent the skin from becoming dry. 

Common ingredients include liquid and white 
soft paraffin. Emollients are available in several 
forms, including creams (the most acceptable form 
to patients), ointments (most effective, but messy) 
and lotions (for mild dryness on the scalp and 
hairy areas). 

Bath emollients and emollient shower gels 
should be used as an adjunct to standard topical 
emollients. Soap substitutes such as emulsifying 
ointment are recommended, as soap can remove 
natural oils and cause the skin to become dry and 
shed further skin cells. 

Emulsifying ointment is effective in treating 
cradle cap in babies. 

Topical emollients should be smoothed onto the 
skin using downward strokes in the direction of hair 
growth, as rubbing them in can increase the risk of 
folliculitis. They should be used liberally all over 
the body as frequently as needed to prevent 
eczema flare-ups. 

There is no specific ranking order of emollients, 
and choice is mainly down to the site and severity 
of the condition and patient preference. Often 
several different emollient preparations are used 
together to achieve optimal management, which is 
known as complete emollient therapy. 

Some excipients and preservatives in emollients 
may be potential irritants, such as fragrances and 
benzyl alcohol. A list of potential sensitising 
excipients is found in the BNF. 2 

Although aqueous cream is commonly used in 
eczema management, it has been found to cause 
skin irritation (possibly due to containing the skin 
sensitisers sodium lauryl sulfate and chlorocresol). 
It should therefore not be recommended as a 

Table 1 : Topical corticosteroid 

MILD eg hydrocortisone 0.1-2.5 per cent (for 
mild eczema, especially on the face and neck) 

MODERATE eg betamethasone valerate 
0.025 per cent, clobetasone butyrate 0.05 
per cent (for moderate eczema) 

POTENT eg betamethasone valerate 0.1 per 
cent (for severe eczema) 

VERY POTENT eg clobetasol propionate 
0.05 per cent (should only be used under 
specialist dermatological advice) 

leave-on moisturiser. All emollients should be 
patch-tested before use on large or sensitive areas. 

Emollients should be prescribed in large 
quantities. Typical amounts used weekly are 600g 
for adults and 250g for children. 3 CPs may 
prescribe adjuvant emollients to treat secondary 
conditions in the skin. 

Emollients may also contain: 

antimicrobials, such as triclosan for widespread 
or recurrent infection 

- lauromacrogols, for their anaesthetic and hence 
anti-itching properties 

salicylic acid, for when an exfoliating action is 

colloidal oatmeal, for its soothing, anti-itching 

humectants, such as urea and glycerine. These 
provide extra hydration by drawing water from the 
dermis into the epidermis. 

It is important to review emollient therapy, as 
the effectiveness and acceptability of an emollient 
can vary with time. 

Topical corticosteroids 

Topical corticosteroids are another mainstay in 
the treatment of eczema. They relieve 
inflammation and itching by inhibiting 
inflammatory mediators. Topical corticosteroids 
are categorised in the BNF 2 into four groups of 
potency, and the least potent preparation which 
effectively controls the condition should always 
be used. 

Topical corticosteroids are the first-line 
treatment for flares of atopic eczema. The choice is 
based on the potency of the product and site and 
severity of the eczema. See table 1 , above, for 


iggis" 19 




▼ 19 Eczema: part 2 


▼ 21 Pharmacokinetics 


^ 26 Category M 

Cream-based topical corticosteroids are more 
suitable for moist, weeping or infected eczema (to 
avoid occlusion), whereas ointment-based topical 
corticosteroids are recommended for dry, cracked, 
scaly, lichenified skin. Topical corticosteroid lotions 
are indicated for inflamed, hairy, widespread or 
exudating lesions. 

For those patients who have been previously 
diagnosed with atopic eczema, pharmacists can 
sell hydrocortisone (mild potency) and 
clobetasone butyrate 0.05 per cent (moderate 
potency) over the counter. 

Hydrocortisone is indicated for treatment of 
mild to moderate atopic eczema for a maximum 
of one week. It cannot be sold for use in children 
under 1 years of age, for use on the face, or for 
women who are pregnant. 4 

Clobetasone 0.05 per cent cream is indicated 
for the short-term treatment and control of small 
patches of moderate eczema and dermatitis, 
including atopic eczema and primary irritant and 
allergic dermatitis, in patients who are aged 12 or 
over. 5 The suitability of the product and the 
diagnosis should be confirmed on supply. 

Topical corticosteroids should be rubbed into the 
skin sparingly up to twice daily. The fingertip unit 1 
can be used to quantify how much product should 
be used. One fingertip unit is the amount of cream 
or ointment squeezed out of the tube from the tip 
of the patient's index finger to the first crease. It is 
enough to treat an area of skin twice the size of the 
flat of an adult's hand with the fingers together. 
Patients should wait several minutes after applying 
an emollient before a topical steroid is applied to 
avoid diluting the steroid. 

Anti-infective agents 

Short courses of oral antibiotics - such as 
flucloxacillin or erythromycin - are 
recommended for eczema if there are signs of 
bacterial infection. Topical antibiotics are not 
generally recommended due to the risks of 
resistance and sensitisation. 

Oral aciclovir 400mg five times a day for five 
days is prescribed for severe eczema herpeticum. 
Ketoconazole shampoos are available to treat 
severe seborrhoeic eczema on the scalp. 

Tar and antimicrobial products 

Tar has anti-pruritic and anti-inflammatory 
properties and is available in several topical forms 
over the counter. Medicated shampoos containing 
antimicrobials, such as pyrithione zinc and 
selenium sulphide, are available for seborrhoeic 
eczema on the scalp. 

Topical immunosuppressa rits 

Two topical calcineurin inhibitors, tacrolimus and 
pimecrolimus, are available to treat atopic 
eczema. Treatment with either of these is 
normally initiated by a dermatologist when 
conventional therapy has been unresponsive. 

Tacrolimus is recommended for moderate 
atopic eczema on face and neck of children aged 
two to 16 years, while pimecrolimus is 
recommended for moderate to severe atopic 
eczema in patients older than two years. 

Calcineurin inhibitors do not cause skin thinning 
like corticosteroids. They are used if topical 
steroids are ineffective, or if continued use 
increases the risk of adverse skin effects, such as 

skin atrophy. Emollients should not be applied to 
the same area within two hours of applying 
tacrolimus ointment. However, emollients can be 
applied immediately after the application of 
pimecrolimus cream. 

Adverse effects 

Occasionally, sensitivity to ingredients used in 
topical treatments may cause a rash, and 
blockage of hair follicles may lead to folliculitis. 

Topical corticosteroids may cause localised 
stinging, burning, depigmentation and thinning of 
the skin. Prolonged excessive potent steroid use 
may cause irreversible striae atrophicae 
(permanent stretch marks due to loss of elasticity 
in the dermis) and telangiectasia (dilated blood 

Particular care must be taken to ensure topical 
steroids don't get into the eye as they can cause 
glaucoma. Parents and carers may also be non- 
compliant with topical steroid treatment due to 
concerns about their side effects (steroid phobia). 

Tacrolimus and pimecrolimus may cause local 
burning sensation, pruritis and erythema. 

Other treatments 

Phototherapy with UVA, UVB, and psoralen plus 
UVA (PUVA) may be considered by specialists for 
refractory chronic atopic eczema. The mechanism 
of action is not fully understood, but has shown 
to have an immunosuppressant action. Patients 
should be advised to avoid sunburn from natural 
sunlight during treatment. 

Oral systemic treatment may be considered for 
severe eczema. Options include ciclosporin, 
azathioprine and alitretinoin (for severe hand 
eczema). Sedating antihistamines may be 
prescribed for severe itching at night. 

Medicated dressings (containing zinc oxide 
paste, coal tar or ichthammol) may be used on top 
of a mild topical corticosteroid to treat non- 
infected chronic lichenification. Wet cotton 
tubular bandages may also be used on top of 
emollients or topical steroids for short-term 
treatment of flares of non-infected chronic 
lichenified eczema. These are then over-wrapped 
with dry bandages. 

Whole-body occlusive dressings or whole-body 
dry bandages should not be used as first-line 
treatments. Compression bandaging may be used 
in patients with venous eczema for the treatment 
of any underlying varicose veins or deep vein 

Complementary therapies such as homeopathy, 
herbal medicine, massage and food supplements 
have not been adequately assessed and cannot 
be recommended. 

National Eczema Society. Tel. 0207 281 3553. 
Helpline: 0800 089 1122. 

British Association of Dermatologists 

Advice for patients 

Adequate compliance with the skin care 
regimen is essential to the optimal 
management of the condition. 

Pharmacists can make several interventions 
to improve compliance with therapy. These 

Demonstrating how to apply topical 
treatments, how much of each product to use, 
and explaining the fingertip unit. Parents and 
carers should be counselled to overcome any 
barriers to 'steroid phobia'. 

Encouraging adequate skin hydration and 
explaining how effective emollient therapy 
has a 'steroid-sparing' effect (a lower dose of 
steroid is needed to treat a flare). 

Advising the patient to avoid trigger factors. 

• Advising the patient to seek medical advice 
if the condition is causing psychological 
problems, stress, sleep disturbances or other 

Checking the correct use of eczema 
management products with an MUR and, if 
necessary, ensuring adequate supplies of 
emollients are prescribed. 

Attaching a dispensing label to the 
individual container (eg tube or bottle). 

Providing details of patient support groups 
(such as the National Eczema Society). 

Advising patients that wearing cotton 
clothing can help keep the skin cool. 
However, patients should be advised to avoid 
irritant clothing such as wool and fabric 

• Informing patients that the early 
identification and treatment of flares can help 
reduce their severity. 

Primary Care Dermatology Society 

Chinjal J Patel MRPharmS PC Dip is a 
community pharmacist in Oadby, Leicester. 

Download a CPD log sheet that helps you 
complete your CPD entry when you 
successfully complete the 5 Minute Test for 
this Update article online (p21). 


1. Nice. Atopic eczema in children. Management of 
atopic eczema in children from birth up to the age 
of 12 years. Nice clinical guideline 57. Dec 2007. 

2. BNF60 September 2010 

3. CKS. Eczema-atopic. Clinical Knowledge 
Summaries 2010; 




Update will return in the 
New Year with a two-part look 
at oral health on January 1 5 

20 Chemist-' Druggist 1 8.1 2.1 

Get Update and Practical Approach emailed to you 


Eczema: part 2 

minute test 

What have you learned? 

Test yourself in three easy steps: 

Step 1 

It's now time to register for Update 2011 and receive a unique PIN 
number - see below for early bird offer 

Step 2 

Access the 5 Minute Test questions on the C+D website at 

Why is aqueous cream not recommended as a leave-on 
moisturiser in eczema management? What is the area of 
skin that one fingertip unit of steroid cream should be 
used to treat? What are the side effects of tacrolimus? 

This article discusses the management and treatment of 
eczema, including information about emollients and 
topical steroids. Side effects and other treatments such 
as topical immunosuppressants, phototherapy and wet 
wrap therapy are also described. 

■ Read the leaflet from the National Eczema Society at, which contains useful 
advice for patients about emollients and how to use 

• Find out more about the use of topical steroids from 
the Patient UK website at 

• Revise your knowledge of the quantities of 
topical steroids that should be used and the fingertip 
unit from the Patient UK website at 

• Think about the advice you could give to your patients 
about how to apply their emollients and topical steroids. 
Could any of them benefit from an MUR? 

Are you now confident in your knowledge of the 
management and treatment of eczema? Could 
you explain to patients about the importance 
of moisturising and how much topical steroid they 
should apply? 

Enrol for Update 2011 before January 31 and pay only £27 + VAT. Sign up 
at or by calling 0207 921 8425. 

Signing up also ensures that C+D's weekly Update article is delivered 
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Get a CPD log sheet for your portfolio when you successfully complete 
the 5 Minute Test online. 

Practical Approach 

Effect of exercise on drug activity 

Lauren Olsen, a GP trainee at a 
practice to which David Spencer 
provides prescribing advice, contacts 
David to discuss an issue that has 
been concerning her. 

"David," she says, "these days 
we're always encouraging our 
patients to take lifestyle measures to 
improve or maintain their general 
health, and I've been quite impressed 
by how many are taking the advice 
seriously and implementing it. 

"A lot of them have taken up 

regular exercise, like running, 
swimming or using a gym, and that's 
great because it obviously brings 
physiological benefits. But, 
particularly in the case of people on 
long-term medication, I wonder 
whether exercise might affect the 
effectiveness of their drugs?" 

"I think I can give you some 
pointers there," replies David. 

1. What are the four processes 
involved in the pharmacokinetics 
of a drug's activity? 

2. What is the additional factor 
connected with exercise? 

3. What is the effect of exercise 
on drug pharmacokinetics, and 
for which drugs has an effect 
been shown? 


1. Absorption, distribution, 
metabolism, excretion. 

2. Blood flow: At rest, the liver and 
kidneys - where much of drug 
metabolism and excretion take place 
- receive about 50 per cent of the 
body's blood flow. During moderate- 
to-intense physical activity, blood is 
redirected from central organs 

(except the heart) to working 
muscles and, as a result, only 3 per 
cent of the body's blood is 
distributed to the liver and kidneys. 
In addition, exercise decreases 
glomerular filtration rates in the 
kidneys by as much as 30 per cent 
and can take more than an hour to 
return to normal afterwards. It is 
therefore advisable not to take 
medication immediately before 
moderate-to-intense exercise. 
3. Drug absorption can occur in 
subcutaneous and transdermal 
tissues; redistribution of blood flow 
to these sites during exercise can 
affect drug absorption. The rate of 
absorption of insulin increases 
significantly after subcutaneous 
injections into working muscles, and 
low plasma glucose levels have been 
reported as a result of the rapid 
absorption of insulin when injected 
into a muscle that is about to be 
actively worked. Exercising with a 
transdermal patch such as 
nitroglycerin or nicotine has also 
produced increased plasma drug 

Exercise has been shown to change 
drug binding to plasma proteins and 
other tissues, increasing during 

exercise, and this in turn may 
influence drug binding to plasma 
proteins and tissues. In addition, 
alterations in drug distribution may 
occur because of redistribution of 
blood to active muscles. Drugs 
shown to be affected in this way 
include theophylline and acebutolol 
Digoxin binding has also been shown 
to be altered during exercise. 

Improved fitness can alter 
metabolic enzyme activity and 
therefore affect drugs whose 
metabolism depends on this 
mechanism, although to date there is 
little evidence of clinical effect. 

LenzTL. Pharmacokinetic Drug 
Interactions with Physical Activity. 
Am J Lifestyle Med. 2010;4:226-229 

Have you got a suggestion for a 
Practical Approach scenario? 
Email haveyoursay@chemistand 

For more Practical Approach 
scenarios, go to www.chemist 

18.12.10 Chemist Druggisi 21 


The year that was... 

C+D takes a look back over the last 1 2 months to see how 201 was for pharmacy 


No sooner has the year kicked off than the 
country grinds to a halt with an arctic 
blizzard. Fortunately the government has an 
idea about how pharmacists in England can 
keep themselves warm, supporting plans to 
substitute generics for branded prescriptions. 
The plans get a mixed vote from pharmacists, 
who recognise the potential savings but not 
necessarily the impact it will have for patients 
(and the hassle for pharmacists). Obesity 
drugs also make the headlines, as the European 
Medicines Agency decides to suspend 
sibutramine after the SCOUT trial shows an 
increased risk of cardiovascular risk. 

Good month for Stop Remote 
Supervision. The campaign's 
candidates claim a landslide 
victory in the professional leadership 
body elections, claiming nine of 11 seats on 
the English board and two on the Welsh one. 


OBad month for: Homeopathy 
the pharmacies that sell it. 
Campaigners target Boots in protest 
against the multiple selling 
homeopathic products, with protesters in 12 cities 
congregating on January 30 to down homeopathic 
products in a "mass overdose". The campaign 
attracts national attention, and generates strong 
debate over whether pharmacists should be 
providing treatments that lack evidence. 

Clockwise from top 
left: Pharmacist John 
Tucker ran six miles in 
the snow to open the 
Weldricks Coldthorpe 
Barnsley Road branch; 
Steve Churton on being 
the last RPSGB 
president; and 
campaigners take a 
mass homeopathy 

Quote of the month, February: 


The Elizabeth Lee saga continues, as the 
Pharmacists' Defence Association (PDA) reveals 
the pharmacist, who was criminally prosecuted 
for a dispensing error despite not being 
responsible for the patient's death, will appeal her 
conviction. It's still bad news for pharmacists 
working under the threat of criminal action, as the 
sector is left waiting for promised guidance from 
the Crown Prosecution Service to protect 
pharmacists from jail for a single dispensing error. 

And it's bad news at the PSNC conference, too, 
as pharmacy minister Mike O'Brien reveals 
services promised in the 2008 pharmacy white 
paper will be funded by shifting cash away from 
other parts of the pharmacy contract. 

Good month for: Helen Cordon. The 
former CEO of the Royal College of 
Obstetricians and Gynaecologists wins 
the role of chief executive of the future 
professional leadership body for pharmacy. 

OBad month for: The CPhC. Pharmacy's 
future regulator faces such heavy 
criticism of its proposed standards that 
it has to go back to the drawing board and 
prepare for a consultation on revised proposals. 


February brings worrying news for contractors 
across the English capital: NHS London announces 
more than 100 polyclinics are set to open by 2013. 
Pharmacists express concern that established 
pharmacies could find themselves sidelined by the 
plans, although guidance is put in place to try to 
protect existing premises. 

In other news, the RPSGB pledges to launch a 
campaign for original pack dispensing, while the 
existence of its regulation successor the General 
Pharmaceutical Council (GPhC) edges that bit 
closer, after the House of Lords approves the draft 
Pharmacy Order. The C+D Senate also gets into 
gear, delivering its verdict on the government's » 
generic substitution plans. 

Good month for: Pharmacists' CPD. 
The RPSGB publishes data on its CPD 
call and review programme, with 
around 80 per cent of pharmacists 
having received an 'excellent' rating. 

OBad month for: Lloydspharmacy. The i 
multiple is forced to announce M 
possible job cuts at its head office, Jak 
driven by reduced funding for 
community pharmacy in England. 

Rowlands Pharmacy 
commercial director 
John D'Arcy on 
*~> otI ,tU» kcS generic substitution 

Pharmacists hit back after David Cameron tells an 
audience at a live election debate that methadone 
treatment doesn't deal with drug misuse, and 
rehab should be used instead. 

Meanwhile, a volcanic ash cloud leaves many 
delegates of the Avicenna conference stranded, 
but does not disrupt the medicines supply chain as 
is feared. The press rages on as pharmacists ask 
themselves if they should be allowed to opt out of 
supplying contraception if they have a 
conscientious objection 

Good month for: Contract 
applications north of the border. The 
Scottish Government announces plans 
to simplify pharmacy applications. 

OBad month for: The NPA and 
Lloydspharmacy. Both have their top 
bods quit this month. John Turk resigns 
from the NPA while Lloydspharmacy MD 
Richard Smith announces he is leaving the chain. 

Quote of the month, April: 

Ian Simpson expresses his shock after former 
colleague and CPP chair Charles Butler (left) is 
convicted of fraud and illegal drugs possession 

22 C. hem is jggist 18.12.10 


C+D announces the results of its Salary Survey 
2010, which shows pharmacists experienced an 
average pay rise of 2 per cent in the previous year, 
but 33 per cent of contractors were forced to cut 
their own pay during the same period. 

Meanwhile, following the lengthy process of 
deciding who is in charge after the first hung 
parliament in 35 years, Earl Howe is named 
pharmacy minister, a move welcomed by many in 
the sector. 

Good month for: Elizabeth Lee 
The court of appeal rules the locum 
convicted of a dispensing error should 
pay a fine of just £300, and overturns 
her jail sentence. 

OBad month for: Sandra Cidley. After 
losing her parliamentary seat, the 
pharmacist-politician warns that the 
House of Commons is a "black hole" for 
pharmacy, as other key political pharmacy 
champions are also ousted from the house in the 
general election 

In an unprecedented act of rebellion, Guernsey 
pharmacists threaten to break from the RPSCB, 
stating that they are set to form their own 
regulatory body 

Following Elizabeth Lee's appeal success the 
previous month, the industry is disappointed by 
the CPS's failure to deliver clearer guidance on 
dispensing errors. 

And the third annual C+D Awards honours the 
best in pharmacy at a ceremony at the Grosvenor 
House Hotel, London. 

Good month for: Healthy Living 
Pharmacies. Six pharmacies are 
accredited with Healthy Living status in 
Portsmouth PCT, attracting adulation 

from the rest of the profession for the scheme's 

achievements so far. 

The most-read news 
stories of 2010 

As viewed at 

been promised. But the 
sector is frustrated to 
hear they "change 
nothing", according to 
legal experts. 

C+D exclusive: Boots boss 
Stefano Pessina talks to I 
C+D in July 

George Romanes, Romanes Pharmacy, Duns 

"The highlight of my year was finally getting 
Scotland's chronic medication service off the 
ground. It's a big thing for us. The worry is that we 
now have to fit it into our routine - it's about 
culture change." 

Bad month for: Dispensing errors. The 
CPS finally delivers guidance on the 
prosecution of dispensing errors, a year 
after they had 


The summer starts on a high for health secretary 
Andrew Lansley, as he launches his health white 
paper, Liberating the NHS. PCTs are to be 
abolished, GP consortia are to take the 
commissioning reins and a new pharmacy contract 
is to be built on payment by performance, the 
policy document for England says. The reaction 
from pharmacy is mixed, with some saying the 
removal of patchy PCTs could be a good thing, but 
always wary of the new commissioning powers for 
GPs. Meanwhile the stock shortages situation 
continues, as C+D reveals the DH has been in 
secret talks with manufacturers of affected drugs, 
and Northern Ireland contractors win £28 million 
in compensation for outstanding money owed to 
them from illegal category M reductions 

Good month for: Alliance Boots. 
Executive chairman Stefano Pessina 
tells C+D he thinks sustained double- 
digit growth is possible for the group, 

saying: "It is our mantra and we strongly believe 

we can achieve it." 

OBad month for: PCTs and minor 
ailments services. The NHS white paper 
sees the announcement that PCTs will 
be scrapped by 2013, while C+D reveals 
trusts across England are considering stopping 
minor ailments schemes in a bid to cut costs. 


As the sun shines down all pharmacy eyes are on 
the English capital, where London mayor Boris 
Johnson is busy backing C+D's campaign to 
highlight pharmacy services such as HPV 
vaccination and minor ailments. Unfortunately, 
just a week later the good news is tarnished as C+D 
reveals London pharmacies were targeted over 200 
times by criminals in 2009, with crimes including 
assault, armed robbery and sexual offences. CPD 
also claims its first victims, with five unnamed 
pharmacists referred to the RPSGB's Investigating 
Committee for failing to meet standards 

Good month for: Machines 
Sainsbury's announces it will be trialling 
"Express Prescription" vending 
machines in two stores, which some C+D 
readers say reduces the profession to glorified 
vending machines; Boots says it will trial 
telemedicine services in two of its flagship stores 

OBad month for: Enhanced services. 
After Surrey pharmacists see their 
smoking cessation service axed in what 
the LPC calls a "major hatchet operation" 
to reduce the PCT's budget, tales of service 
suspensions follow from across the country. 

Quote of the month, July: 

PharmaPlus MD Hiten Patel, 
on the plans to scrap PCTs 






Category M dominates the early autumn 
headlines with the announcement that 
contractors face a £140 million clawback to be 
taken in three waves: £60m in October, a further 
£60m in January and the remaining £20m over 
the course of the next financial year. PSNC warns 
pharmacies to prepare for the cutbacks; multiples 
criticise the clawback and say they will need to 
make a series of spending cuts to manage; and 
experts warn the cuts could be the tipping point 
for some smaller businesses. 

Good month for: Medicines 
management services. Pharmacists 
could cut care home medication errors 
by 91 per cent if given full responsibility 
for medicines management, a trial carried out by 
Midhurst Pharmacy in London suggests. 

OBad month for: Medicines stocks. 
The C+D Stock Survey 2010 reveals the 
extent of shortages problems, with 80 
per cent of pharmacists saying getting 
hold of branded medicines is tougher than ever. 
Patients fare no better, as C+D receives 42 
accounts of patient trauma caused by shortages, 
ranging from anxiety and distress to hospital 

Octc ber 

The RPSCB may have finally gone the way of the 
dodo only the previous month but its memory is 
tarnished almost immediately as October kicks off 
with a report on its handling of disciplinary cases, 
a record that experts variously describe as 
"appalling", "horrendous" and "obscene". The 
same week, Helen Cordon promises a "very 
different" leadership body, as C+D puts readers' 
questions to the new RPS chief. 

It's a busy month for C+D, as our PCT 
Investigation reveals "shocking" enhanced service 
spend variation across the country, and the C+D 
Conference at the Pharmacy Show hears former 
health secretary Alan Milburn lambast pharmacy's 
lack of political clout. 

Good month for: Mike Holden. 
The Portsmouth Healthy Living 
Pharmacy initiative - in the Hampshire 
& Isle of Wight LPC of which he is chief 
officer - publishes an interim report detailing its 
successes, as Mr Holden is named the next chief 
executive of the NPA. 

OBad month for: Generic substitution 
and Avandia. The government ditches 
plans to allow pharmacists to dispense 
generics against branded scripts, while 
the popular rosiglitazone-based type 2 diabetes 
treatment is withdrawn. 

Quote of the month, November 

Quote of the month, 

Lloydspharmacy's Andy 
Murdock on the need for 
pharmacy to step up to 
the plate to realise the 
potential of the public 
health white paper 

This was the year that.... 
Twitter hit pharmacy 

'vim * i 
in n 

PSNC chief executive Sue Sharpe 

1 1 i uf 

C+D first joined micro-blogging site Twitter 
back in 2009, but 2010 was the year it really 
became an integral part of how we deliver 
news and talk to our readers, having amassed 
almost 800 followers of @chemistdruggist 
and others through the individual C+D team 
members' accounts (below). Here's a sample 
of our year in Tweets: 

@CandDChris "I ate his liver with some fava 
beans and a nice chianti" - Lecter is listing 
three foods you can't eat if you're on MAOI 

@CandDJennifer Wondering how pharmacy 
is going to react to a study that says partial 
relaxation of control of entry has had 
"significant benefits"... 
@>ChemistDruggist Sue Sharpe performs a 
mime of category M on stage. Wish I'd had 
my camcorder. Marcel Marceau, eat your 
heart out 

@CandDChris just going through the 
blacklist. Drs are not allowed to prescribe 
Nescafe Instant Coffee or Perrier Mineral 
water on the NHS. The odd thing is that to 
appear on the blacklist of products on NHS, 
those had to be prescribed at some point... 
@Squeela - 1 never thought I would hear the 
words "Toxic Mega Colon" but I just have. It's 
almost made my day 
@GaryParagpuri RPS is promoting its 
'support functions' when it should be 
promoting its 'make a difference' function, 
/here is the Obama-esque slogan? 
'CandDHannah I have just spoken to a 
pharmacist whose PCT has asked him to go 
clubbing in a glow-in-the-dark condom, 

: ind out what it's all about at 


Prescription pricing errors are back in the 
headlines, branded "ludicrous" after PSNC 
reveals contractors are likely to need further 
compensation from NHS Prescription Services. 
Reimbursement and funding also dominates the 
annual LPC Conference, with contractor 
representatives calling purchase profit clawbacks 
"manifestly unfair" and dispensing at a loss 
"morally indefensible". 

The conference also sees PSNC launch web- 
based system PharmaBase for managing and 
building evidence for enhanced services, and 
pharmacy minister Earl Howe back a national 
pharmacy service for people prescribed a 
medicine for the first time. 

Good month for: Boots and Asda 
The former reports a revenue rise of 
6 per cent in the first half of this 
financial year, as the latter opens its 

200th pharmacy and announces expansion plans 

for 2011 

OBad month for: The RPS. Almost 900 
members are revealed to have quit in 
the two months since the new 
leadership body shed its regulatory role 
(and mandatory membership for pharmacists). 


The year goes out with a bang with the 
publication of England's much-anticipated public 
health white paper, which praises pharmacy as "a 
valuable and trusted public health resource". 
Pharmacy welcomes the policy cautiously, 
warning that the "warm words" need to be backed 
by action. Earl Howe also says that pharmacists 
must be used more to affect the proposals in the 
year's earlier NHS white paper. 

Meanwhile, national organisations the NPA, 
CCA and AIMp promise to represent pharmacy in 
a stronger, more united way with the formation of 
Pharmacy Voice, a new organisation to cover their 
representation functions. 

Good month for: John D'Arcy. The 
Rowlands commercial director and one- 
time NPA chief executive is appointed 
managing director at sister company 
Numark, after Tony Mottram steps down. 

OBad month for: GP-pharmacist 
relationships. A C+D online poll finds 
that just 5 per cent of pharmacists 
have talked to their local practices 
about CP consortia, and only 7 per cent 
more have plans to do so. Pharmacy 
representatives brand the findings 

Taseen Iqbal, Modi's Pharmacy, Dudley 

"On a personal level, the highlight of my year has 
been winning the C+D Community Pharmacist of 
the Year Award 2010. But for pharmacy it's been 
a hard slog, with services being decommissioned 
and more category M clawbacks." 

24 Chemist: Druggist 18.12.10 



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19 Eczema: part 2 

21 Pharmacokinetics 

26 Category M 

Category M Barometer 

Generic Eric reveals how January's tariff will affect your pharmacy 

he category M tariff will see a 
continuation of stability into the New 
Year, with a marginal addition to the 
reimbursement pot of 1.2 per cent. 

The adjustment is in the region of a £4.5 million 
addition, once market growth has been factored 
in. This will see almost £340 added to the average 
pharmacy's generic purchase profits over the 
coming quarter, or £113 a month. 

Despite the overall stability, however, out of 
442 products, just 29 remain at the same 
reimbursement level as last quarter. 

Most of the savings to the NHS have been made 
by reducing the reimbursement price for 
risperidone 4mg tablets, which this quarter loses 
87 per cent of its value. Other prominent 
reductions are topirimates and the losartans, which 
have taken a further knock for the third quarter 
since they entered the tariff last year. 

There have been 10 other significant additions 
to the category, in addition to risperidone, and 
many of these were in the top 10 decreases in 
reimbursement (see What's not, right). 

This quarter sees the removal of just two 
products: ascorbic acid 500mg tablets and 
flucloxacillin 125mg/5ml oral solution. 

The new basket of category M products is 
worth £1.35 billion, up £16. 3m. The Category M 
Barometer index has now decreased from 103.9 in 
the previous quarter to 102.6 for this quarter. 

On the most commonly dispensed lines by 
volume, reimbursement prices have decreased on 
only seven products this quarter. In fact, an 
annualised amount of £7.8m has been added to 
these lines (£75m removed last quarter). 

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C+D Awards 201 1: entry now open 

Triple whammy 

Zoe Smeaton finds out how Taseen Iqbal earned 
three shortlistings and a win at the C+D Awards 201 0, 
as the Community Pharmacist of the Year 

When Taseen Iqbal joined Modi's Pharmacy in misuse help. Taseen has played a key role 

Dudley, West Midlands, patients didn't know what in many of these, such as by helping to evaluate 

had hit them. The pharmacy went from offering a pharmacy supervised consumption services in 

few clinical services to being a healthcare hub for the area. 

the community with a new pharmacist, dedicated And the effort has been paying off, as more 

to his patients. services are now available and script volumes in 

"I've always wanted to work with people and the pharmacy have risen by 15 per cent since 

pharmacy was a way to do that while also being he arrived. 

science-related," says the C+D Community The achievements saw him shortlisted three 

Pharmacist of the Year 2010. And he says it is this times at the C+D Awards 2010, for Community 

people contact, and specifically the ability to Pharmacist of the Year as well as New Pharmacist 

make a difference to somebody's life, that keeps and Pharmacy Manager of the Year, 
him motivated. Taseen has also found time to take a clinical 

His favourite story is that of an 85-year-old primary care diploma. The diploma made him 

smoker who was finding breathing increasingly more aware of what services he could offer and 

difficult and was struggling even to walk to the better skills for how to give patients advice. He 

pharmacy. The patient didn't see the point in also works part time for the PCT. 
quitting smoking at his age. But Taseen didn't He believes in taking healthcare to the 

give up, and eventually convinced and helped community and has helped run several events, 

him to stop. such as those in mosques, to encourage people 

The patient now finds walking much easier, can from ethnic minorities to donate blood, 
get to the shop and back without stopping, and has And the work doesn't stop now, as Taseen has 

been an inspiration to other patients. been promoted to clinical services manager for 

It seems that this dedication to patients is the the company and will be working to improve 

secret to Taseen's success. This applies to service provision across the group's other 

everything from services to pharmacy layout. branches. 

For example, Taseen was responsible for steps He says healthy heart checks could be the 

such as moving a large gondola to open the next in line for development and another focus 

pharmacy up and make space for more seating will be making sure the services they have got 

for patients. are sustainable given the current risk of 

When he came to the pharmacy, it wasn't doing decommissioning. 

many additional or enhanced services. But since 

then Taseen has worked hard to develop services, Watch Taseen explain how he became C+D 

such as language-specific smoking cessation, Community Pharmacist of the year 2010 

needle exchange, chlamydia testing and alcohol 

Taseen's 5 top tips to make your pharmacy the best 

1. Scrap appointments: "We don't do organised and having some drive and 
appointments for things like smoking enthusiasm. Keep thinking about how you can 
cessation services because a lot of the time improve things rather than just accepting the 
patients don't come back. I always make the status quo." 

effort to see them there and then, even if it's 

only just for five minutes, otherwise you might 4. Make patients comfortable: "We used 

lose them." to have a big gondola in the middle of the 

pharmacy, but I took that out, which made the 

2. Get talking: "You've got to be integrated in pharmacy feel more spacious and gave us room 
your local community. Collaborate with them, for more seats for patients." 

talk to your patients and always give them time. 

Brief interventions can really make a difference 5. Work with surgeries: Taseen has played an 

so it's worth repeated messages to people when important role in developing services within the 

they come in." PCT and says a vital part of this has been 

developing relationships with local surgeries and 

3. Keep motivated: "It's all down to being telling them about services. 


In association with 


National Pharmacy 
I Association 

Community Pharmacist 
of the Year 

(• ' C <• (• f» fi 
^1 ^ /♦ ^ ^ 

Taseen Iqbal 

Pharmacy: Modi's Pharmacy, Dudley, West 

Award won: C+D Community Pharmacist of 
the Year 2010 

Award entry: Taseen has shown a real 
dedication to tackling health inequalities, 
transforming the pharmacy's clinical services 
offering and boosting script volumes. 

What the judges said: "Taseen has provided a 
shining example of community-focused 
pharmaceutical excellence." 

Top award tip: "Try to get testimonials from 
GPs and patients as evidence that you have 
made a difference." 

Down time: Taseen does everything from 
jumping out of planes to half-marathons. 

You could be C+D Community Pharmacist of 
the Year 2011. Entry for the C+D Community 
Pharmacist of the Year 2011, sponsored byTeva 
UK, is now open. Co to www.chemistand for full entry details, 
hints and tips to make your entry stand out, 
to enter online or to download an entry form. 

28 Chemist +Druggist 18.12.10 

Merry Christmas and a Happy New Year from the team at C+D Jobs 


0207 921 8456 

Booking and copy date 
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18.12.10 Chemist --Druggist 29 


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32 Chemist- Druggist 18.12.10 

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At last, the practice mortgage that gives you the freedom of 
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Contact George Knox on 
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Cost effective specialist legal advice 
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We can assist with buying, selling, merging 
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Hilary D'Cruz or Jas Singh 
01543 466 660 


As the leading tax consultants to retail pharmacists we 
have clients throughout the UK. 

We know many pharmacists are happy with their accountants 
but are not getting proactive tax advice. 

We have the answer. You don't need to change accountants 
- we can work alongside them solving your tax problems 
and advising you how to reduce your tax bills. 

Some clients like a total service provider - others like 
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that suits you" 

Call us NOW to discuss how we can help you? 
Phone Anne Hutchings on: 01494 722 224 


Hutchings & Co. 

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Maple House, 
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HP6 6AA 






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For more information or for a 
FREE consultation please call Umesh 

on 020 7383 3200 







Got a story for Postscript? 

A jolly Christmas indeed 

C+D Christmas 
Competition 2010 

Sponsored by 


Making lives better 

The Day Lewis Pharmacy Riverhead branch in Kent (above) is the winner of this 
year's C+D Christmas Competition. Their festive display has won them a 
Harrods hamper. Well done to the team! 

C+D reader of the week 

Meet pharmacy manager Amanda Wells from Day Lewis 
Pharmacy in Erith, London, who prefers brown sauce to red 

If you could, what disease would you eradicate? 

I would like to be able to eradicate cancer. 

What's the best thing about working in your 
pharmacy? We have a good time and all the staff 
are very jolly and happy 

What's your favourite book? I am currently 
reading one about people's experience of ghosts. 

What's the best idea you have ever had? to 
move our stock around so that it sold better 

What do you want for Christmas? I would like 
some perfume. I smelled a very nice Yves Saint 
Laurent one in the airport recently. 

What will you have for lunch on Christmas 

day? Turkey and gammon, the works 

Hsove you got any plans for Christmas? It will 

be me and my husband and children, we will be 
playing games, eating lots and generally having a 
good time. 

If someone gave you £1,000, what would you 
spend it on? I would take my children away to 
somewhere nice and warm in the sun. 

Where are you next going on holiday? I would 
like to go to Paris again, as I went last October and 
really enjoyed it. 

Red sauce or brown? Brown 

What should we ask our next reader of the 

week? If you could have any superpower what 
would it be and why? 

Calling all pharmacists and technicians. We 
want you to be our reader of the week. Email 
us at 

@The web hunter 

A lot can happen in a year and 2010 is no 
exception. We've had two governments, 
consisting of three political parties, each with its 
own ideas on health provision. What was also 
central this year was the drive to use IT to make 
health provision more efficient and effective. 

For pharmacy, this meant pressing ahead with 
the roll out of EPS2, which would finally connect 
CPs and pharmacies. The mood was optimistic. 
Cegedim Rx was confident that the roll out of 
EPS2 would happen in May. 

And in CP land, patient summary care records 
would revolutionise the way patients could access 
their medical records. 

But then cracks started to appear, with 
problems hitting the approval process for EPS2, 
creating more delays. And CPs were given 
permission to opt out of summary care records 
after up to 200,000 patients were put at risk by 
inaccurate records, according to the medical press. 

But a new government added fresh impetus to 
IT and healthcare as internet entrepreneur Martha 
Lane Fox became the LibCon technology adviser 
and technology was set out in the heart of new 
health secretary Andrew Lansley's health white 
paper, Liberating the NHS. 

And there have been some positives as in 
August Cegedim Rx finally gained approval for 
EPS2. And, in October, Andrew Lansley insisted 
the government would press ahead with the roll 
out of summary care records. 

But the issue as ever will be money. While IT 
might save the NHS bundles of cash in the future, 
right now it needs investment. And perhaps this 
will come from the private sector as highlighted 
by 02's launch of 02 Health. 

But IT will also need buy-in from healthcare 
providers and their customers - the patients. 
Without this, it won't matter how clever a bit of 
kit is - it will end up on the scrapheap with 
Betamax and HD DVD and will cost the taxpayer 
a fortune. 

Niall Hunt is C+D's digital content editor; 
email him at 

A social tweet 

Join the debate at 

@CandDChris: RPS members have voted around '■ 
to 1 yes to allowing students and associate 
members into RPS from March next year 

@BPSA: We would like to thank everyone who 
voted YES to accept students and preregistration 
pharmacists into the RPS: 

34 Chemist:- gist 18.12.10 


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